Purpose of reviewThe epidemiology of liver disease in people living with HIV has evolved since the arrival of effective hepatitis C virus (HCV) treatment. Nonalcoholic fatty liver disease (NAFLD) in HIV patients is highly prevalent while hepatitis D, hepatitis E, and occult hepatitis B remain underappreciated. We discuss mechanisms of fibrosis in HIV and review clinical outcomes of HIV-associated liver diseases. Recent findingsHIV-HCV co-infection is receding as a cause of progressive liver disease, but fibrosis biomarkers after HCV treatment remain elevated. Antiretroviral therapy (ART) with anti-hepatitis B virus (HBV) activity promotes stable liver disease, but oversimplifying ART regimens in unrecognized suppressed HBV may lead to activation of HBV. A high prevalence of fibrosis and rapid progression of fibrosis are seen in HIVassociated NAFLD, with visceral fat as a major risk factor. Newer ART such as integrase strand inhibitors may have limited intrinsic hepatoxicity but do increase weight, which may secondarily lead to hepatic steatosis. Promising therapies for HIV-associated NAFLD include tesamorelin and CCR5 blockade agents. SummaryOur understanding of the natural history and pathogenesis of liver diseases in HIV has advanced and adapted to the changing landscape of liver disease in this population. Future research should evaluate long-term clinical and histological outcomes, prevention strategies, and treatment options to improve morbidity and mortality in HIV-related liver diseases.
Discussion: This is a rare case of infiltrative hepatic metastasis with biliary and sinusoidal involvement due to vaginal SCC. Sinusoidal infiltration of the liver by malignant cells is rare and can be seen in cases of lymphoma, breast adenocarcinoma and neuroendocrine tumors. Sinusoidal infiltration may lead to portal hypertension that mimics cirrhosis. This case serves as an important reminder that not all cases of portal hypertension are from liver cirrhosis. When a thorough work up is unrevealing, malignant infiltration in the appropriate clinical setting should be considered.[3133] Figure 1. A, Metastatic squamous cell carcinoma involving the sinusoidal and biliary spaces (note arrows) (403). B, P16 positive metastatic squamous cell carcinoma to the liver identical to the vaginal primary (103). C, Vaginal biopsy with venous invasion of squamous cell carcinoma (H&E 403). D, CD31 marking endothelial cells of vein with intraluminal vaginal squamous cell carcinoma (403).
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